Provider Demographics
NPI:1619215910
Name:IPEKTCHI, DEEPA MADHAVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:MADHAVAN
Last Name:IPEKTCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FATHERS CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4929
Mailing Address - Country:US
Mailing Address - Phone:516-238-1873
Mailing Address - Fax:
Practice Address - Street 1:3299 CHERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1827
Practice Address - Country:US
Practice Address - Phone:516-785-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist